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Some with lung cancer get unhelpful radiation

March 1, 2012

Last Updated: 2012-02-29 12:00:26 -0400 (Reuters Health)

By Amy Norton

NEW YORK (Reuters Health) - Older adults who have surgery for a particular type of lung cancer often have radiation therapy afterward. But a new study suggests that the radiation typically does nothing to extend their lives.

The findings, which appear in the journal Cancer, highlight the overall issue of "overtreatment" in medicine -- that is, giving patients tests and treatments that lack strong evidence of a benefit.

In this case, researchers looked at government data on elderly Americans treated for a particular stage and type of non-small cell lung cancer.

Non-small cell lung cancer accounts for about 90 percent of lung cancer cases in the U.S., but it's further divided into complicated groupings based on the size of the tumor and other factors.

Patients in this study had stage 3, N2 lung cancer, which means it had spread to particular nearby lymph nodes. People with that type of lung cancer can have surgery to remove the cancer -- and it's been thought that radiation after surgery could help their chances of avoiding a cancer recurrence.

But the actual research evidence on that has been mixed. And in general, experts have recommended against routinely using radiation for these patients.

The current findings back up that advice, according to Dr. Juan P. Wisnivesky of Mount Sinai School of Medicine in New York.

Using a government database, Wisnivesky's team was able to look at long-term survival among 1,300 Americans age 65 and up who had surgery for stage 3, N2 lung cancer between 1992 and 2005.

More than half of those patients -- 54 percent -- received radiation therapy after surgery. But overall, their survival odds over the next three years were no better than those of patients who had no radiation therapy.

INDIVIDUALIZED CARE

In general, most people do not survive this form of lung cancer for long.

If there's only "microscopic" disease in the N2 lymph nodes, five-year survival rates range from 20 to 35 percent. But the outlook is dimmer when the cancer has invaded the lymph nodes more extensively.

Based on the current findings, radiation after surgery may not improve patients' survival chances.

But treatment decisions should still be based on individual patients' situations, according to Wisnivesky.

"I think this treatment option should be discussed with patients," he told Reuters Health in an email, "but physicians should be clear that there is no strong evidence from (clinical trials) supporting use of post-operative radiation therapy."

Along with the lack of a clear survival advantage, there's the big issue of side effects, Wisnivesky pointed out.

Radiation therapy can cause fatigue, nausea and vomiting, or damage the lungs or esophagus (the passage through which food moves into the stomach).

But Wisnivesky also stressed that his findings relate only to elderly adults with stage 3, N2 lung cancer. They don't say whether the effects of radiation might be different for younger patients or those with different lymph-node involvement.

$800 BILLION IN WASTE?

The study had its limitations, the authors note. It's based on information from a cancer registry, and not a clinical trial where patients were randomly assigned to have radiation therapy or not -- which is considered the "gold standard" in medical research.

But the researchers did account for a number of possible differences between radiation and no-radiation patients -- like their overall health and demographics.

What's really needed, according to Wisnivesky, is a clinical trial that tests radiation versus no radiation in this group of lung cancer patients. Just such a trial is underway in France, but it will be several years before it's finished.

More broadly, the issue of unproven medical tests and treatments is grabbing more attention, as the U.S. government seeks to control costs while extending healthcare coverage to millions more Americans.

Earlier this month, the American College of Physicians said it was rolling out new guidelines on when doctors should perform various screening and diagnostic tests, and when they can be avoided.

According to some estimates, the U.S. wastes about $800 billion -- or about one-third of all annual healthcare spending -- on unneeded medical tests, procedures and extra days in the hospital.

SOURCE: http://bit.ly/wGJGOu Cancer, online February 13, 2012.

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